Running head: HOURLY ROUNDS AND FALL PREVENTION 1

Hourly Rounds and Fall Prevention

Aida D. Zuniga

Bon Secours Memorial College of Nursing

NUR 4144: Professional Role Development-Servant Leadership

March 28, 2017

I pledge
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Quality Improvement Project

All around the country, the idea of hourly nurse rounding has gained popularity in recent

years as a quality improvement initiative that may decrease the occurrence of patient falls and

injuries, and improve patient outcomes overall (Brosey & March, 2015, p. 156) The basic

concept behind hourly rounding (as it relates specifically to preventing patient falls) is that by

making contact with the patient at least once every hour, the nurse can address any of the

patients immediate needs, thus lowering the risk of patients falling while getting out of bed

without assistance or supervision. Overall, the research surrounding this quality improvement

project supports the use of hourly nursing rounds to improve patient safety and decrease the

number of patients falls and subsequent injuries (Brosey & March, 2015; Goldsack, Bergey,

Mascioli, & Cunningham, 2015; Morgan et al., 2016; Tucker, Bieber, Attlesey-Pries, Olson, &

Dierkhising, 2012).

Heart Domain

To have the heart of a servant leader is to exalt God only (Blanchard & Hodges, 2005,

p.63). By doing this, an individual lets go of their fear and pride, and focuses on their true calling

to serve God by caring for the sick and injured. Nurse managers working to implement hourly

rounds or any quality improvement project for that matter on their unit may face challenges.

However, by remaining humble, and working to serve God, these nurses will endure. As

mentioned above, hourly nursing rounds have the potential to dramatically reduce patient falls

and injury. In fact, according to one study, implementation of hourly rounds resulted in a fifty

percent decrease in patient falls over a one year period (Morgan et al., 2016, p. 119). Nurses are

called by God to care for His children on earth mind, body, and soul. It is no small undertaking,
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but by having their hearts in the right place and implementing changes such as hourly rounds,

nurses continue to do the Lords call to serve.

Head Domain

The head domain of servant leadership refers to a leaders belief system. For that belief

system to be shared with others, the servant leader must define his or her vision. (Blanchard &

Hodges, 2005, p.114) By establishing a vision for incorporating hourly nursing rounds into

clinical practice, the nurse manager can then move forward with the support of the nursing staff

to the implementation stage (Blanchard & Hodges, 2005, p. 115). During the implementation

stage, steps can be taken to form new policies pertaining to hourly rounds, and goals can be set to

encourage adherence to these new policies.

Hands Domain

While the hearts and hand domains of servant leadership are more about the mental

preparation required to lead, the hands domain is more physical, so to speak. To fulfill the hands

domain of servant leadership, a nurse manager must act as a teacher/coach, and help guide his or

her fellow nurses through the four different levels of learning: novice, apprentice, journeyman,

and master (Blanchard & Hodges, 2005, p. 138). As it pertains to implementing the quality

improvement project of hourly rounding, it falls to the nurse manager to assess the needs of the

bedside nurses on the unit, as implementing a new policy can be difficult for everyone involved.

According to one study, Nurses interpreted structured nursing rounds interventions (SNRIs) as

an imposition and the documentation a burden, (Tucker, Bieber, Attlesey-Pries, Olson, &

Dierkhising, 2012). In a situation such as this, the nurse manager would need to provide

encouragement, coaching, and evaluation to promote compliance to the new hourly rounding

policy (Blanchard & Hodges, 2005, p. 150).

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Habits Domain

The five habits of a servant leader include: solitude, prayer, study and application of

Scripture, accepting and responding to Gods unconditional love, and involvement in supportive

relationships (Blanchard & Hodges, 2005, p. 154). Practicing these five habits as Jesus did can

help the nurse manager to move forward in serving Gods people. By evaluating his or her

actions and reflecting on how they have impacted the community, the nurse manager can make

changes such as implementing a new policy for hourly rounding as necessary to better serve

the sick and injured.

Model the Way

To model the way, a nurse manager must be consistent in what he or she says, and in

what he or she does. In short, the nurse managers actions must be congruent with their actions

(Ellcessor, 2017, p. 6). Regarding implementation of the hourly rounding quality improvement

project, the nurse manager can model the way by picking up the slack for the bedside nurses

when possible, to exemplify that hourly rounding is a change in policy that he or she is

committed to. For example, if the unit is short-staffed one day, and the nurse manager has some

extra time on their hands, he or she could make rounds for the nurse with the heaviest patient

load on occasion. One article on the benefits of hourly rounding even remarked that, active

involvement of leadership [] as unit champions during the project run-in period was critical to

significantly reducing inpatient fall rates, (Goldsack, Bergey, Mascioli, & Cunningham, 2015,

p. 25).

Inspire a Shared Vision

Inspiring a shared vision begins with the nurse manager envisioning the future

(Ellcessor, 2017, p. 12). By implementing a policy for hourly nursing rounds, the nurse manager
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is envisioning a future with fewer patient falls and injuries. It is also the job of the nurse manager

to collaborate with other administrative figures, as well as with the floor nurses, in hope of

uniting everyone to work towards a common goal the reduction of patient falls and injury.

Implementing change is difficult, but can be made easier if everyone is on the same page. When

everyone is on the same page, the team (everyone involved in implementing change) understands

why what they are doing is so important, and appreciates the positive impact their change in

policy (hourly nursing rounds) can have.

Challenge the Process

By advocating for quality improvement projects on their units, nurse managers are

challenging the process. Rather than becoming complacent and accepting the status quo, the

nurse manager displays exemplary leadership skills by looking for opportunities to improve

existing practice (Ellcessor, 2017, p. 14-16). Once policy changes to implement hourly nursing

rounds have been enacted, the nurse manager can continue to challenge the process by looking

for ways to encourage bedside nurse compliance to the new policy changes, as well as by

seeking out other areas in need of improvement on the unit.

Enable Others to Act

A nurse manager must enable others to act if he or she wants to build trust with the nurses

on the unit. By establishing trust and building relationships with fellow nurses, the nurse

manager lays the foundation for harmonious collaboration in the future (Ellcessor, 2017, p. 18).

After a new change in policy such as hourly nursing rounds has been implemented on a unit, a

nurse manager must be able to trust the bedside nurses (and vice versa), and depend on them to

do their part by complying with the new policy change and documenting accordingly. If the floor

nurses feel they lack the full trust of the nurse manager, the policy change may fall through.
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Furthermore, the nurse manager may end up doing much more work than necessary (Ellcessor,

2017, p. 18).

Encourage the Heart

The last of the five exemplary practices of leadership is to encourage the heart. This

practice is all about giving credit where and when credit is due. By recognizing the efforts of the

nursing staff to comply with new policy changes in this case, the use of hourly nursing rounds

the nurse manager lets everyone know that their work is appreciated (Ellcessor, 2017, p. 20).

Nursing is difficult enough without having to adjust to new policies, but receiving positive

feedback from nurse managers creates a sense of pride and accomplishment for the nursing

community on the unit. It also allows the nursing staff to feel capable and confident in

themselves and their abilities.

Professional Practice Implications

The author of this paper read through four peer-reviewed journal articles, all of which

supported the use of hourly nursing rounds as a means to reduce the incidence of patient falls and

injury (Brosey & March, 2015; Goldsack, Bergey, Mascioli, & Cunningham, 2015; Morgan et

al., 2016; Tucker, Bieber, Attlesey-Pries, Olson, & Dierkhising, 2012). In fact, one article even

reported as high as a fifty percent decrease in the occurrence of patient falls over a one year

study in which hourly rounds were implemented (Morgan et al., 2016, p. 119). With that said, the

obvious first professional practice implication is that hourly nursing rounds serve as a method of

increasing patient safety (which is always considered a top nursing priority) by reducing patient

falls/injuries. By reducing the number of patient falls, hospitals may also indirectly shorten the

average length of patient stays. The second professional practice implication is that hourly

nursing rounds have been linked to an increase in patient satisfaction and improvement in
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HCAHP scores (Brosey & March, 2015, p. 156). As technology has progressed, it has become

easier for patients to look up information (such as HCAHP scores) about the healthcare providers

in their area. High HCAHP scores reflect well on a hospital, and thus, patients are more likely to

choose albeit inadvertently the hospital that is implementing hourly nursing rounds.

Outcome Evaluation

By laying eyes on patients at least once an hour, a nurse has a greater chance of

preventing an adverse event, such as a patient fall. Patient falls often occur because the patient

feels they can no longer wait for the nurse to assist them, or because they are not alert and

oriented. When a confused or physically weak patient leaves the safety of their bed to use the

bathroom or to get an item out of their reach without the help of a nurse or health professional,

the risk of a fall occurring increases exponentially. The fact of the matter is that patients are not

admitted to a hospital because they are in excellent health. When a patient is admitted to the

hospital, it is because they are sick or hurt. As such, confused and physically weak patients are

all too common in hospitals. The risk of falls and injuries is very real and ever-present. Research

has shown that hourly nursing rounds are an effective, low-cost way to drastically reduce the

incidence of patient falls (Brosey & March, 2015; Goldsack, Bergey, Mascioli, & Cunningham,

2015; Morgan et al., 2016; Tucker, Bieber, Attlesey-Pries, Olson, & Dierkhising, 2012). It is the

authors recommendation that hourly nursing rounds be implemented on all hospital units

nationwide as a step toward improving patient safety.

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References

Blanchard, K., & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient

satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159.

http://dx.doi.org/10.1097/ncq.0000000000000086

Ellcessor, B., (2017). Five practices of exemplary leadership (PowerPoint slides). Retrieved

from https://bsmcon.blackboard.com/webapps/blackboard/content/listContent.jsp?

course_id=_2842_1&content_id=_143593_1

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient

falls: What factors boost success. Nursing, 45(2), 25-30.

http://dx.doi.org/10.1097/01.nurse.0000459798.79840.95

Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston, C., & McCulloch, P. (2016).

Intentional rounding: A staff-led quality improvement intervention in the prevention of

patient falls. Journal of Clinical Nursing, 26(1-2), 115-124.

http://dx.doi.org/10.1111/jocn.13401

Tucker, S., Bieber, P., Attlesey-Pries, J., Olson, M., & Dierkhising, R. (2012). Outcomes and

challenges in implementing hourly rounds to reduce falls in orthopedic units. Worldviews

on Evidence-Based Nursing, 9(1), 18-29. http://dx.doi.org/10.1111/j.1741-

6787.2011.00227.x